Persistent acute kidney injury following transcatheter aortic valve replacement.

Authors:
Charat Thongprayoon
Charat Thongprayoon
Mayo Clinic
Phoenix | United States
Wisit Cheungpasitporn
Wisit Cheungpasitporn
Bassett Medical Center and Columbia University College of Physicians and Surgeons
United States
Michael A Mao
Michael A Mao
Mayo Clinic College of Medicine
Narat Srivali
Narat Srivali
Bassett Medical Center and Columbia University College of Physicians and Surgeons
United States
Wonngarm Kittanamongkolchai
Wonngarm Kittanamongkolchai
Bassett Medical Center and Columbia University College of Physicians and Surgeons
United States
Dr Andrew M Harrison, MD, PhD
Dr Andrew M Harrison, MD, PhD
Mayo Clinic
Postdoctoral researcher
Clinical Informatics
Rochester, MN | United States
Kevin L Greason
Kevin L Greason
Mayo Clinic
Dubai | United Arab Emirates
Kianoush B Kashani
Kianoush B Kashani
Mayo Clinic
United States

J Card Surg 2017 Sep 22;32(9):550-555. Epub 2017 Aug 22.

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota.

Background: Acute kidney injury (AKI) and its severity after transcatheter aortic valve replacement (TAVR) have been associated with worse outcomes. Studies have shown that AKI duration (transient or persistent) affects outcomes independently of AKI severity. This study was undertaken to determine the association, risk factors, and outcomes associated with persistent AKI (pAKI) after TAVR.

Methods: Adult patients undergoing TAVR at Mayo Clinic between January 1, 2008 and June 30, 2014 were enrolled. pAKI was defined as an increased serum creatinine at hospital discharge (≥0.3 mg/dL or ≥50% from baseline). Risk factors associated with pAKI were identified with multivariate logistic regression.

Results: A total of 386 patients met the inclusion criteria. Fifty patients (13%) had pAKI. Independent risk factors for pAKI on multivariate analysis included diabetes mellitus (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.29-4.66), prior percutaneous coronary intervention (PCI) (OR, 2.39; 95%CI, 1.24-4.80), intra-aortic balloon pump (IABP) use (OR, 8.14; 95%CI, 1.60-45.78), and blood transfusion (OR, 2.22; 95%CI, 1.15-4.27). Protective factors for pAKI included a higher baseline estimated glomerular filtration rate (eGFR) (OR, 0.83 per 10-mL/min/1.73 m increase in eGFR; 95%CI, 0.71-0.99). After adjusting for the Society of Thoracic Surgeons cardiac surgery risk score, pAKI occurrence remained significantly associated with increased 2-year mortality among hospital survivors (hazard ratio, 2.65; 95%CI, 1.51-4.41).

Conclusion: pAKI was significantly associated with higher mortality risk following TAVR. Baseline eGFR, diabetes mellitus, previous PCI, IABP, and blood transfusion were risk factors for post-procedural pAKI.

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http://dx.doi.org/10.1111/jocs.13200DOI Listing

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September 2017
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